| NPI | 1376306183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1536221123) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-ZWRITX) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2025-12-17 |